Last year, after the NPSGs were finalized, healthcare organizations faced one new National NPSG in preparation for 2008 requiring clinicians to respond rapidly to changes in a patient's condition, and another new requirement about anticoagulant therapy, and was intended to be a light year for NPSG changes. Unlike in previous years, the 2008 goals will be phased in throughout the year, with full implementation required by January 2009.

Goal 1Under the proposed revisions, Requirement 1A would be expanded to include an IE requiring that the patient is actively involved in the identification process, when possible, before any venipuncture, arterial puncture, or capillary blood collection procedure. Proposed Requirement 1C aims to eliminate transfusion errors related to patient misidentification.

Goal 7Perhaps most newsworthy is the inclusion of a new proposed requirement aimed to stop drug resistant organism infections in hospitals. Specifically, proposed Requirement 7C targets MRSA and CDAD. Among its 16 IEs, 7C requires education for healthcare workers, patients, and their families, as well as the measurement and monitoring of infection rates. It also requires lab-based alert systems when MRSA patients are detected, and a surveillance system for CDAD.

Requirement 7D proposes 13 IEs, including IEs for before and after insertion of the catheter. Requirement 7E has both general and specific IEs, seven in total, for the prevention of SSIs.

Goal 8Proposed revisions to Goal 8 are composed of new and revised requirements and IEs intended for clarification, not alteration, of previous requirements. Revisions have been made to Requirements 8A, 8B, and 8C, for the reconciliation of patient medication across the continuum of care. A Requirement 8D has been added requiring modified medication reconciliation processes in settings where medications are not used, used minimally, or prescribed for short durations, such as outpatient radiology, ambulatory care, and behavioral healthcare.

Goal 13Two IEs have been proposed to Goal 13, which targets increasing patient involvement in their own care. The first new IE would require facilities to provide patients with information regarding infection control (for example, hand hygiene or respiratory hygiene practices), while the latter requires facilities to provide surgical patients with information on preventing adverse events during surgery (such as patient identification or surgical site-marking processes).

Universal ProtocolProposed changes to the Universal Protocol, like those made to Goal 8, are not meant to change the overall concept of the Goal, but rather to clarify existing requirements. According to the draft 2009 NPSGs, the Universal Protocol contains the same concepts as it has in previous iterations.

Extensive clarifications have been proposed for Requirements 1A, 1B, and 1C, including four rewritten IEs under 1B (surgical site marking), and six rewritten IEs under 1C ("time out" verifications).

At press time, The Joint Commission did not respond to a request for comment.

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